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NPI Code Detail

MEDICARE: JAMES ELDON LEAN MD SC

MEDICARE: JAMES ELDON LEAN MD SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician35461WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
135461OTHERWISTATE LICENSE #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326145426
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMES ELDON LEAN MD SC
Provider Business Mailing Address
First Line : 101 THOMPSON RD
Second Line :
City : WASHBURN
State : WI
Zip : 54891-4525
Country : US
Telephone Number : 715-373-5388
Fax Number :
Provider Business Practice Location Address
First Line : 101 THOMPSON RD
Second Line :
City : WASHBURN
State : WI
Zip : 54891-4525
Country : US
Telephone Number : 715-373-5388
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JAMES ELDON LEAN
Credential : MD
Telephone Number : 715-373-5388
Provider Enumeration Date : 09/20/2006
Last Update Date : 08/22/2020

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